In February 2025, the U.S. Food and Drug Administration approved the first adaptive, or self-adjusting, deep brain stimulation (DBS) system for Parkinson’s — the Medtronic Percept.
This advance brings enhanced capabilities to the existing Percept system, which was first approved in 2020. It not only senses brain signals linked to motor symptoms, but also adjusts stimulation in response to those signals, in real time, to more evenly control symptoms. This is a major advance in DBS device technology, a field that has seen several recent improvements including enhanced battery life as seen in devices produced by Abbott and Boston Science.
To learn more about adaptive DBS, I spoke with Helen Bronte-Stewart, MD, MSc, a movement disorders neurologist and DBS researcher at Stanford University in Palo Alto, California. Dr. Bronte-Stewart served as principal investigator of the ADAPT-PD trial, which studied adaptive DBS in people with Parkinson’s. The Michael J. Fox Foundation provided funding for the earliest stages of research into this new technology, providing the crucial de-risking support that is the bridge between early research and innovations that improve the lives of people with Parkinson’s.
Rachel Dolhun, MD, DipABLM (RD): Let’s start with deep brain stimulation. What is it?
Helen Bronte-Stewart, MD, MSc (HBS): DBS is like a pacemaker for your brain. With DBS, we place thin wires, or leads, into the brain and deliver electrical stimulation through those wires to lessen motor symptoms. We program stimulation settings to ease symptoms, and that stimulation is on 24/7, which is why we call it “continuous” DBS.
Adaptive DBS senses a person’s unique brain signals and rhythm and automatically responds to rhythm fluctuations that cause Parkinson’s symptoms.
RD: Let’s talk about brain rhythms.
HBS: Our brains have a normal rhythm, called beta rhythm, which is how cells talk to each other. In Parkinson’s, the beta rhythm takes over the brain’s movement circuits. The rhythm “synchronizes,” jamming signals so information can’t get through.
Think of it like this – the way your brain works is like you at a cocktail party. Everyone is having conversations and there’s a hum, but you can easily hear your neighbor. When the system malfunctions, as in Parkinson’s, it’s more like a protest where everyone chants the same thing loudly and you can’t hear yourself speak.
RD: So DBS gets the brain back into a normal rhythm?
HBS: Yes, deep brain stimulation lifts off the abnormal synchronization and keeps the normal beta rhythm. That eases symptoms, like slowness, stiffness and tremor.
The trouble is that we use DBS and medication together, and both suppress the abnormal rhythm. So the rhythm could go too high or low depending on how much medication is on board. That could mean dyskinesia or return of symptoms. We want to keep beta stable to keep symptoms stable.
RD: How does adaptive DBS do that?
HBS: Adaptive DBS senses when medication kicks in, which knocks down the beta rhythm. Instead of staying at the same level, adaptive DBS decreases its own intensity so beta doesn’t go too low. Similarly, as medicine washes out, adaptive DBS increases its intensity to even things out. So these two therapies work together in a more biological and organic way.
RD: What’s the research on adaptive DBS?
HBS: We’ve been studying this for at least 10 years. The Michael J. Fox Foundation was key to getting this off the ground with funding in 2014. Ours and another model of adaptive DBS were, in small, separate studies, shown to be safe, tolerable and efficacious. Following that positive data, I served as principal investigator of a large, international, randomized controlled trial called ADAPT-PD, which compared these two models to each other and to continuous DBS. We anticipate publishing those results soon.
RD: Who might be a candidate for adaptive DBS?
HBS: Currently, anyone who has the Medtronic Percept. This device’s brain wires, or leads, can sense a person’s unique brain signals.
If you wish to try adaptive DBS, your programmer does what we call a signal check to ensure there is enough signal in the brain to drive adaptive DBS. There may not be enough if the brain wire is not optimally placed or if there is tremor temporarily covering it up.
Right now, I would not recommend that any of my patients who have DBS change their device if it’s working well. But for people who are considering DBS, this device and its adaptive capability may be a consideration.
RD: What does adaptive DBS programming look like?
HBS: From the perspective of the person with Parkinson’s, very similar to continuous DBS. Your programmer adjusts settings, testing for side effects or symptom benefits. It will mostly be different on the programmer’s side, and there will be a learning curve. The programmer will set a range of settings within which the system will automatically adjust itself and they’ll also set how fast the system adjusts itself. As we do with continuous DBS, we’ll tweak those setting over time, based on what works and doesn’t work, to find the best range for you.
RD: How big of a step forward is this?
HBS: It’s a big one, but it’s just the beginning. This is a new way of pacing the brain, which we haven’t done since we first started using DBS in the 1990s. I see us on a similar path to cardiac pacemakers. These started as devices that couldn’t sense heart rhythm and now there are all kinds of devices with sophisticated pacing algorithms for all kinds of heart disease. The approval of adaptive DBS opens up a realm of new possibilities in research and care.
RD: Where will DBS go from here?
HBS: First, we’ll learn how to best use adaptive DBS. There’s already a registry to gather data on how we use, in whom, etcetera so that we can optimize delivery and programming. This will help everyone collectively learn faster. Second, our technology will continue to improve – we’ll have better leads and better algorithms to sense brain signals and adjust stimulation or even predict symptoms. Third, we may see adaptive DBS for other brain conditions, like dystonia or essential tremor. And we may see DBS as a whole expand to treat more Parkinson’s symptoms — we’re launching a study to see if it might stabilize early cognitive change and others, funded by MJFF, are studying adaptive DBS for freezing of gait.
RD: Anything else?
HBS: If it weren't for our patients with Parkinson's who volunteer for this type of research, we wouldn’t have this development. I’ll never forget the first gentleman who enrolled in an early study on this work, when we were just learning how to sense brain signals. He said, “I know this is not going to help me, but it's going to help my tribe and that's why I'm doing this.” People with Parkinson’s are so unbelievably kind and generous, and they make this sort of advancement happen.
